9 Symptoms of Anorexia Nervosa

Anorexia nervosa, commonly called anorexia, is a serious eating disorder in which a person adopts unhealthy and extreme methods to lose weight or avoid gaining weight.

There are two types of the disorder: restrictive eating and binge eating/purging.

Those with restrictive anorexia control their weight by restricting their food intake, while those with binge eating/purging anorexia expel what they have eaten through vomiting or the use of medications like laxatives and diuretics.

A complex variety of factors influence the development of anorexia. However, it usually develops in those with low self-esteem and a great need to control their environment.

People at the highest risk of developing anorexia include females in their teenage and young adult years, although men and older women are also at risk (1, 2).

Anorexia is usually not quickly diagnosed because patients, especially adolescents, rarely present themselves as having a problem (3).

People with anorexia tend to be very reserved and secretive, making it difficult for others to notice symptoms.

Furthermore, no single test can identify the disorder, as many factors need to be considered to make a formal diagnosis.

Constant worry about food and the close monitoring of calorie intake are common characteristics of anorexia.

People with anorexia often record every food item they consume, including water. Sometimes, they even memorize the calorie content of foods.

The constant obsession with food motivates those with anorexia to decrease their intake dramatically and practice extreme diets. Some may refuse to eat certain foods or entire food groups, such as carbohydrates or fats.

These actions can lead to severe malnutrition and nutrient deficiencies, which can alter mood and increase obsessive behavior about food (5, 6).

Decreased food intake can also affect appetite-regulating hormones, like insulin and leptin. This can lead to other health problems such as bone-mass loss, as well as reproductive, mental and growth issues (7, 8).

Summary Excessive concern about food is a hallmark of anorexia. Practices include logging food intake and refusing to eat certain food groups due to the belief that those foods may increase weight.

In addition, reducing food intake can lead to a deficiency of nutrients involved in mood regulation (18).

Summary Mood swings and symptoms of anxiety, depression, perfectionism and impulsivity are usually found in people with anorexia. These characteristics may be caused by hormonal imbalances or nutrient deficiencies.

Body shape and attractiveness are critical concerns for people with anorexia (19).

The concept of body image involves your perception of your body size and how you feel about your body (20).

Anorexia is characterized by having a negative body image and negative feelings toward the physical self (21).

In one study, participants showed misconceptions about their body shape and appearance. They also exhibited a high drive for thinness (22).

A classic characteristic of anorexia involves body-size overestimation, or thinking you are bigger than you actually are (23, 24).

One study investigated this concept in 25 people with anorexia by having them judge whether they were too big to pass through a door-like opening.

Those with anorexia significantly overestimated their body size, compared to the control group (25).

Repeated body checking is another characteristic of anorexia. Examples of this behavior include looking at yourself in a mirror, checking body measurements and pinching the fat on certain parts of your body (26).

Body checking can increase body dissatisfaction and anxiety, as well as promote food restriction in people with anorexia (26, 27).

Additionally, evidence shows that sports in which weight and aesthetics are a focus can increase the risk of anorexia in vulnerable people (28, 29).

Furthermore, the reward value of food is altered in those with anorexia. As a result, people with this disorder can find weight loss more gratifying than eating, perpetuating the self-starvation behavior (12, 39, 44).

Summary A constant fear of gaining weight can cause people with anorexia to refuse food and deny hunger. Also, the low reward value of food can lead them to further decrease their food intake.

Those engaged in binge eating/purging are about 18 times more likely to abuse alcohol and drugs than the restricting type (48, 49, 50).

In some cases, alcohol abuse is followed by drastic reductions in food intake to compensate for the calories consumed through drinking (51).

Moreover, the abuse of other drugs, including amphetamines, caffeine or ephedrine, are common in the restrictive type, as these substances can suppress appetite, increase metabolism and promote rapid weight loss (52).

Food restriction and rapid weight loss can affect the brain in ways that may further increase the desire for drugs (53, 54).

What’s more, reduced food intake produced by the prolonged abuse of these substances can cause malnutrition and trigger other health problems.

Summary Anorexia can lead to the abuse of alcohol and certain drugs to help decrease food intake or calm anxiety and fear towards food.

Excessive weight loss is a main sign of anorexia. It’s also one of the most concerning.

The severity of anorexia depends on the extent to which a person suppresses their weight. Weight suppression is the difference between a person’s highest past weight and their current weight (55).

One study showed that weight suppression had significant links to weight, body concerns, excessive exercise, food restriction and the use of weight control medication (56).

Guidelines for the diagnosis of anorexia consider weight loss to be relevant if the current body weight is 15% below the expected weight of a person of that age and height, or if the body mass index (BMI) is 17.5 or less (57).

However, weight changes in a person can be difficult to notice and may not be enough to diagnose anorexia. Therefore, all other signs and symptoms need to be considered to make an accurate determination.

Summary Extreme weight loss is a significant sign of anorexia, such as when body weight drops below 15% of the expected weight for a person of that age and height, or their BMI is less than 17.5.